Provider Demographics
NPI:1104912344
Name:COHEN, PHILLIP MARC (DPM)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:MARC
Last Name:COHEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2208 OLD EMMORTON RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-8909
Mailing Address - Country:US
Mailing Address - Phone:410-515-7800
Mailing Address - Fax:410-515-7805
Practice Address - Street 1:2208 OLD EMMORTON RD
Practice Address - Street 2:SUITE 101
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015-8909
Practice Address - Country:US
Practice Address - Phone:410-515-7800
Practice Address - Fax:410-515-7805
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1078213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1104912344OtherNPI - INDIVIDUAL
MD097988100Medicaid
MD1104912344OtherNPI INDIVIDUAL PHILLIP COHEN
MD1134271505OtherNPI- GROUP
MDK603OtherMEDICARE PTAN
MDK603OtherBLUE CROSS BLUE SHIELD OF MARYLAND
MD097988100Medicaid
MDK603OtherBLUE CROSS BLUE SHIELD OF MARYLAND